Provider Demographics
NPI:1720427446
Name:SHIMONOVA, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:SHIMONOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9834 63RD DR
Mailing Address - Street 2:APT 4B
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2338
Mailing Address - Country:US
Mailing Address - Phone:718-899-9060
Mailing Address - Fax:
Practice Address - Street 1:9834 63RD DR
Practice Address - Street 2:APT 4B
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2338
Practice Address - Country:US
Practice Address - Phone:718-899-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-15
Last Update Date:2013-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program